Eliminating Barriers to Care Through Telemedicine
Where the ocean, mountains, and desert are within an hour’s drive of each other, strong industry, cultural diversity, adequate transportation, strong involvement and response to community needs mean opportunity, opportunity, and opportunity for all who live here. So, why are there, in this seemingly ideal community, barriers to healthcare?
Written by: Lisa Verschueren, BSBM, Telemedicine Program Manager
San Diego, California -- Lack of health coverage, transportation or child care, as well as cultural barriers and geographic isolation, are examples of barriers to health care faced by many Californians.
The Council of Community Clinics, and its subsidiary organization, the Community Clinic Health Network, have developed a solution to remove geographic isolation as a barrier to care. The Council of Community Clinics represents and supports 17 community clinic corporations in San Diego and Imperial counties, which operate at over 70 clinic locations. These clinics care for over 400,000 patients in over 1 million patient visits. At least 20 of these clinic sites are in rural East San Diego County, Imperial County, and rural parts of Riverside County.
The incorporation of information technology and healthcare known as telemedicine has set the stage for an innovative and effective way of delivering medicine across vast geographic areas. This technology has sparked the forming of regional models throughout the state focused on providing healthcare services to those who might not otherwise have been able to access the care without this advanced technology.
With a grant awarded by the California Telemedicine and eHealth Center (CTeC) located in Sacramento, San Diego's Community Clinic Health Network has formed the Agricultural Worker Research Project (AWRP), which uses videoconferencing technology to allow a patient at one location to see a specialist in another location. This technology allows patients to access specialty care, from the comfort of their primary care clinic, and without the traditional costs of travel, daycare, and time away from home or work. One of the main purposes of the project is to evaluate how often agricultural workers in these rural areas use the service, as well as their satisfaction with the services. However patient satisfaction is being measured with all patients, as is provider satisfaction in using this technology. So far the marks are favorable!
The project consists of 13 sites, all of which have videoconferencing equipment allowing them to connect to the network's pool of specialty providers. Participating clinics include Mountain Health and Community Services (3 sites), Clinicas de Salud del Pueblo (6 sites), La Maestra (2 sites), Sycuan Medical and Dental Center (1 site), Borrego Medical Center (1 site), and the Council of Community Clinics, which provides administrative oversight and videoconferencing bridging services.
Providers include network physicians, nurse practitioners, certified nurse midwives, and other mid-level practitioners. Telemedicine services are reimbursed by Medicare, Medi-Cal, and private insurance payers. And Governor Schwarzenegger recently signed a bill authorizing store-and-forward technology to be a reimbursable service. This technology involves sending and receiving data such as x-rays that have been stored rather than delivered in a real time setting. Dermatology, psychiatry, pain management, radiology, and ophthalmology are examples of services lend themselves well to this type of technology.
Clinics began providing telemedicine consults on September 1, 2005. Patients are now able to return to their primary care site and seek specialty services hundreds of miles away. Patients are offered the option to return to a familiar and convenient location which minimizes fear and the stress of how they will get to the specialist office.
Each site has a telemedicine site coordinator who has been trained at UC Davis' Telemedicine Learning Center by experienced instructors in the telemedicine field. Some topics include how to educate patients on the components of telemedicine, their right to privacy, HIPAA concerns, health information exchange, and the convenience it affords. Patients are also informed of their right to decline telemedicine services, and obtain their consult in a traditional manner. Patients within the AWRP service area are receptive to this technology and, to date, have not declined services when offered. Contrarily, patients were excited about how the technology could help them get the care they need. Patients who participate in group education through telemedicine also have the opportunity to establish relationships and provide and receive support with those who share similar medical conditions.
Providers benefit from engaging in telemedicine as well. Primary care physicians are able to learn about specialty care by being involved in the telemedicine consult. Further, providers are able to participate in professional organizations, fulfill continuing medical education requirements through distance learning, engage in staff and supervisory meetings, and conduct quality management reviews. The reduced travel time between clinics or to and from educational institutions allows providers more clinic time to see patients, thus reducing appointment wait time. Travel costs are also reduced by the providers' ability to fulfill professional and educational obligation through teleconferencing.
Uniform policies have been developed to ensure continuity of care throughout the network, while careful not to interfere with each clinic's own operational procedures. Additionally, project expansion is expected to include other sources of specialists such as university health systems and other regional networks throughout the State of California. It is without a doubt a win-win situation for providers and patients. After all, improved access to care creates healthier communities!
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Established in 1977, the Council of Community Clinics (CCC) is composed of 17 community clinic and health center organizations operating more than 75 primary care sites throughout San Diego and Imperial counties. The mission of the CCC is to represent and support community clinics and health centers in their efforts to provide access to quality health care and related services for the diverse communities they serve with an emphasis on low income and uninsured populations. For more information, please call (619) 542-4300 or visit online at www.ccc-sd.org.